Herald View: The devil in the health data
The NHA data on healthcare expenditure released this week reveals that public health expenditure, reflecting what the government spends, was a meagre 1.28% of GDP in 2018-19, the lowest since 2004-05
The NHA (National Health Accounts) data on healthcare expenditure released this week brings to mind an old saying about statistics, about what they reveal and conceal. What the headlines focused on is what the government would possibly find sufficiently distracting: total health expenditure in the country was 3.2 per cent of GDP. The less flattering reality, not made explicit in this data byte, is that 3.2 per cent of GDP is the overall expenditure on healthcare, including what the private sector invested and what people spent out of pocket. Public health expenditure, reflecting what the government spends, was still a meagre 1.28 per cent of GDP, the lowest since 2004-05, lower even than a year prior (1.35 per cent in 2017-18) and paltry in comparison with economies with superpower claims or ambitions. For perspective, the United States, in 2020, spent 19 per cent of its GDP on health. For more context, the National Health Policy, announced by the Modi government in 2017, targeted public health expenditure of 2.5 per cent of GDP by 2025.
The NHA data also reveals that the government’s per capita health expenditure of Rs 1,815 in 2018-19 was less than the out-of-pocket per capita health expenditure of Rs 2,155. India’s total per capita health expenditure has changed little over this period, rising from Rs 3,174 in 2013-14 to Rs 3,314 in 2018-19. That’s no increase in real terms, i.e. accounting for inflation. Total healthcare expenditure in terms of GDP declined from 4 per cent in 2013-14 to 3.2 per cent in 2018-19. The NHA estimates also show that private hospitals account for a much bigger chunk of health expenditure—Rs 1,55,013 crore compared to Rs 93,689 crore in government hospitals. Those statistics, for a country still heavily dependent on government and government-funded services, make dismal reading. The Covid-19 pandemic really showed us up. If, as the government admits, a majority of the population still survives on free or heavily subsidised rations, where is the money to spend on healthcare? Where do they even go for healthcare, given the yawning infrastructure gap, the abysmally poor coverage at the district and lower levels. Statistics do not tell the whole wretched story.
An Oxfam report published during the pandemic put India’s health expenditure as the fourth lowest in the world. Around 80 per cent of Indian families, the report said, would be faced with financial ruin if just one member of the family needed serious medical attention. Just about half the Indian population even today can avail of the most rudimentary health services. Beyond the cities, reliable healthcare, ambulance services and emergency care are extremely unreliable. The Ayushman Bharat Yojana was billed as this panacea with promises to provide free health coverage to 40 per cent of the population. Even apart from the fact that this was for tertiary care only, requiring hospitalisation, allocations for the scheme did not support the claims made for it. All too often there are reports in the media of hospitals and insurance companies refusing to treat patients or bear the cost of treatment on some pretext or the other. That our public healthcare system is still broken is not really in doubt, even if the government is in denial of that reality.
That we still lack the political will or the vision to prioritise it, even after the shaming experience of the pandemic, is what really boggles the mind.